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Breast Cancer in Patients With Residual Invasive Carcinoma is More Accurately Staged With Additive Tumor Size Assessment

From the Department of Surgery (STH, CC, MPO, RMS) and Department of Public Health (PC), Weill Medical College of Cornell University; and the Strang Weill Cornell Breast Center (YV-R, DM, MN, MPO, RMS), New York, NY.

Correspondence: Address correspondence and reprint requests to: Rache M. Simmons, MD, Strang Weill Cornell Breast Center, 425 East 61st Street, 8th Floor, New York, NY 10021; Fax: 212-821-0832; E-mail: rms2002{at}med.cornell.edu

Background: Accurate assessment of tumor size for patients with breast cancer undergoing re-excision following breast-conserving therapy is important for appropriate staging and adjuvant treatment. We investigated the accuracy of additive vs. nonadditive size assessment in determining final tumor stage.

Methods: Patients with infiltrating carcinoma in the initial excision and in at least one additional re-excision (re-excision positive; n = 89) had tumor size assessed with additive and nonadditive techniques. This group was compared with patients undergoing re-excision but without identifiable residual carcinoma (re-excision negative; n = 105) regarding rates of lymph node (LN) metastasis.

Results: The re-excision positive patients had a different median final tumor size depending on the size assessment technique used (nonadditive: 1.8 cm; additive: 3.0 cm; P < .0001). Both groups of patients had a median tumor size consistent with T1c staging in nonadditive size assessment. However, re-excision positive patients had a significantly higher incidence of LN metastasis (P < .05) than did re-excision negative patients. Both groups were then separated into T1 and T2 stages and the LN metastasis rates were assessed. Compared with nonadditive size assessment, additive size assessment distributed re-excision positive patients into T stages whereby the LN metastasis rates more closely approximated those of re-excision negative patients (T1, 3% vs. 6% difference; T2, 4% vs. 13% difference).

Conclusions: With regard to LN metastasis, staging for patients with residual invasive carcinoma in re-excision specimens is more accurate with additive tumor size assessment.

Key Words: Breast neoplasm • Positive margins • Re-excision • Tumor size

This article has been cited by other articles:

				C. Cellini, S.T. Hollenbeck, P. Christos, D. Martins, J. Carson, S. Kemper, E. LaVigne, E. Chan, and R. Simmons Factors Associated With Residual Breast Cancer After Re-excision for Close or Positive Margins Ann. Surg. Oncol., October 1, 2004; 11(10): 915 - 920. [Abstract] [Full Text] [PDF]